Evaluating the Injection of Platelet-Rich Plasma on Second Lower Molars Protraction: A Randomized Controlled Clinical Trial.

Background The use of platelet-rich plasma (PRP) in dentistry was entered several decades ago, yet its clinical use in orthodontics still requires further investigation. The aim of this study was to evaluate the possible effects of local injection of PRP on the rate and type of mandibular second molar protraction movement compared with the comparator (no PRP) group. Material and methods Eighteen patients aged between 17 and 25 years were randomly allocated in a split-mouth study design to receive PRP injections on one side immediately before the start of molar protraction (PRP group), while the other side received only saline solution (comparator group). Eligibility criteria included bilaterally extracted mandibular first molars cases and indicated mandibular second molars protraction. The primary outcome of the study consisted of measuring the rate of molar protraction from the beginning of protraction (T0) to the end of the seventh month (TF), using a digital gauge. The secondary outcome included measuring the type of second molar protraction movement between T0 and TF by lateral cephalometric images. Randomization of the intervention side was performed by picking out opaque sealed envelopes. The blinding of the principal investigator was impossible but blinding of the patient was achieved by injection of saline. Analyses were done using paired samples T-test to compare the changes in all variables between T0 and TF. The level of significance was taken at a P-value < 0.05. Results No significant difference was detected between the PRP and comparator groups in the rate of second lower molar protraction during seven months (0.56±0.07 mm per month in the comparator group, whereas, was 0.6±0.11 mm per month in the PRP group). Molar protraction parameters in both groups showed second lower molars moving by controlled tipping closer to bodily movement (Root Movement:Crown Movement≈0.8). Conclusions Platelet-rich plasma (PRP) is ineffective in accelerating the rate of orthodontic tooth movement (OTM) during molar protraction, and it has no effect on the type of tooth movement. In addition, the mechanics that we used (6 mm power arm in combination with miniscrews) are effective in mandibular second molar protraction by controlled tipping closer to bodily movement.

National survey of barriers to colorectal cancer screening in Jordan.

Background: Colorectal cancer is among the leading malignancies globally and in Jordan. It causes significant morbidity and mortality. It can be detected early, but uptake of colorectal cancer screening in Jordan is substantially low. Aim: To determine the underlying barriers to the uptake of colorectal cancer screening in Jordan. Methods: A cross-sectional study was conducted in the northern, central and southern regions of Jordan using selfadministered questionnaire that evaluated the barriers and attitudes towards colorectal cancer screening among adults aged 45 years and above living in Jordan. The data was analyzed using SPSS version 25.0. Results: Of the 1477 participants enrolled in the study, 29.1% reported the lack of information about screening as a major barrier to uptake, followed by the fear of any potential complications due to the test (10%), embarrassment associated with colonoscopy (7.8%), and fear of the result (7.4%). Only 9% of the study participants had taken the colonoscopy test for colorectal cancer screening. Conclusion: Lack of information about colorectal cancer screening, misconceptions and embarrassment drive the low uptake of colorectal cancer screening in Jordan. There is a need for nationwide education and awareness on colorectal cancer screening to address the barriers reported in this study and increase screening uptake.

"H" is not for hydroxychloroquine-"H" is for heparin: lack of efficacy of hydroxychloroquine and the role of heparin in COVID-19-preliminary data of a prospective and interventional study from Brazil.

BACKGROUND: COVID-19 pandemic is the major public health problem in the world actually. It's associated with high morbidity and mortality. To date, no therapeutic measure has a curative potential. Hydroxychloroquine (HCQ) is a drug with immunomodulatory properties that has demonstrated antiviral efficacy in in vitro experiments, with conflicting results in in vivo studies. METHODS: A single-center, prospective and interventional study, that evaluates the impact on mortality of the HCQ use in 154 patients hospitalized with COVID-19 in a Brazilian public hospital. The study also aims to determine prognostic factors that predict mortality, ICU admission and endotracheal intubation in this population. RESULTS: 154 patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized were included. There was a male predominance (87/154, 56.5%), median age 60 years and 88% (136/154) had comorbidities. Among these, 76% (117/154) were admitted to the ICU and 29.2% (45/154) experienced EOT. The OMR was 51.3% (79/154). There was no difference in mortality between patients treated with HCQ (N = 95) and non-HCQ (N = 59) (44.1% × 55.8%, p = 0.758). In univariate analysis, age ≥ 60 years (HR 3.62, p < 0.001), need for mechanical ventilation (HR 2.17, p = 0.001), ≥ 2 comorbidities (HR 1.83, p = 0.049), SAH (HR: 1.56, p = 0.054) were predictors of mortality, as well as no use of prophylactic or therapeutic heparin (HR 3.60, p = 0.02). Multivariate analysis identified admission to the ICU (HR 8.98, p = 0.002) and advanced age (HR 3.37, p < 0.01) as independent predictors of mortality, although, use of heparin (HR 0.25, p = 0.001) was independently associated with a favorable outcome. CONCLUSION: This study confirmed the absence of a benefit associated with the use of HCQ in Brazilian patients hospitalized with COVID-19. However, prophylactic or therapeutic heparin was an independent predictor for reducing mortality in this population.

Patterns of hepatitis B virus S gene escape mutants and reverse transcriptase mutations among genotype D isolates in Jordan.

BACKGROUND: Hepatitis B virus (HBV) is an important infectious cause of morbidity and mortality in Jordan. HBV genotype D is the most prevalent in the country. Virus escape mutants in the HBV S region is an important public health problem halting preventive efforts. The aim of the current study was to investigate patterns of HBV escape and resistance mutations and to assess domestic transmission of the virus. METHODS: Patients infected with HBV were recruited at Jordan University Hospital (n = 56) and were diagnosed during (1984-2012). A total of 37 partial HBV S sequences were generated using Sanger's method. Mutation analysis was done using the HIV grade HBV drug resistance interpretation online tool and Geno2pheno (HBV) online tools. Domestic transmission of HBV was assessed using maximum likelihood phylogenetic inference with similar GenBank sequences. RESULTS: Genotyping revealed an exclusive presence of sub-genotype D1. Typical HBV escape mutants were identified in seven patients. These mutations included: L109R, Q129R, M133L, S143L and D144E with overall prevalence of 18.9% (95% CI [9.5-34.2]). Reverse transcriptase (RT) sequence analysis showed mutations in three patients with overall prevalence of 8.1% (95% CI [2.8-21.3]). RT mutations included: V173L, S202I, L180M, M204V and T184A. Transmission cluster analysis revealed a relatively high proportion of infections taking place as a result of domestic spread (29.7%). CONCLUSIONS: Based on our findings, RT mutation analysis appears to be of high value before the initiation of therapy in patients with chronic HBV infection in Jordan. Phylogenetic analyses revealed a considerable proportion of local spread in the country which should be considered in the preventive infection control efforts.

Specific expression and function of the Six3 optix in Drosophila serially homologous organs.

Organ size and pattern results from the integration of two positional information systems. One global information system, encoded by the Hox genes, links organ type with position along the main body axis. Within specific organs, local information is conveyed by signaling molecules that regulate organ growth and pattern. The mesothoracic (T2) wing and the metathoracic (T3) haltere of Drosophila represent a paradigmatic example of this coordination. The Hox gene Ultrabithorax (Ubx), expressed in the developing T3, selects haltere identity by, among other processes, modulating the production and signaling efficiency of Dpp, a BMP2-like molecule that acts as a major regulator of size and pattern. However, the mechanisms of the Hox-signal integration in this well-studied system are incomplete. Here, we have investigated this issue by studying the expression and function of the Six3 transcription factor optix during Drosophila wing and haltere development. We find that in both organs, Dpp defines the expression domain of optix through repression, and that the specific position of this domain in wing and haltere seems to reflect the differential signaling profile among these organs. We show that optix expression in wing and haltere primordia is conserved beyond Drosophila in other higher diptera. In Drosophila, optix is necessary for the growth of wing and haltere. In the wing, optix is required for the growth of the most anterior/proximal region (the 'marginal cell') and for the correct formation of sensory structures along the proximal anterior wing margin; the halteres of optix mutants are also significantly reduced. In addition, in the haltere, optix is necessary for the suppression of sensory bristles.

Hyperammonemic Coma in an Adult due to Ornithine Transcarbamylase Deficiency.

Objective. To report an unusual cause of coma in an adult. Design. Case report. Setting. University teaching hospital. Patient. A previously healthy 53-year-old man initially presented with altered mental status and progressed to coma. He was found to be substantially hyperammonemic and did not improve with lactulose therapy and continuous venovenous hemodialysis. Results. Biochemical testing revealed previously undiagnosed ornithine transcarbamylase deficiency, and the patient responded to arginine, sodium phenylacetate, and sodium benzoate. Conclusion. Even in adult patients with no known history, inborn errors of metabolism must be considered in the differential diagnosis of unexplained coma. Defects of the urea cycle can present with an unprovoked hyperammonemic coma.

Hepatitis C virus quasi-species dynamics predict progression of fibrosis after liver transplantation.

BACKGROUND: The dynamics of hepatitis C virus (HCV) quasi species in the E2 region may correlate with the course of infection after orthotopic liver transplantation (OLT). METHODS: Thirty-four patients who underwent transplantation for HCV-related cirrhosis were studied. Serum and liver samples were available before OLT and at 1 week, 4 months, and 1 year after OLT. Patients were divided into group 1 (Knodell/Ishak fibrosis stage [FS] at 1 year, <2) and group 2 (FS at 1 year, > or =2). Complexity was estimated by the number of bands in a single-strand conformational polymorphism assay, whereas diversity was measured by Shannon entropy (SE) and median mobility shift (MMS) values derived from the heteroduplex mobility assay. Diversity dynamics were measured at transmission (before OLT vs. 1 week after OLT) and after OLT (1 week after OLT vs. 1 year after OLT). RESULTS: Complexity was higher in group 1 patients than in group 2 patients before OLT (P<.02) and at 1 week after OLT (P<.04). Diversity decreased in group 1 at transmission, as measured by either SE (P<.01) or MMS (P<.04). However, diversity increased in this group after OLT, as measured by SE (P<.03) or MMS (P<.02). FS at 1 year after OLT correlated with transmission changes, as measured by SE (r=0.642, P<.0001) and MMS (r=0.443, P<.04), and with post-OLT changes (for SE: r=-0.583, P<.01; for MMS: r=-0.536, P<.01). CONCLUSIONS: HCV complexity and diversity in the E2 region correlated with the severity of recurrence of HCV infection after OLT. Increased diversity of quasi species at transmission correlated with a higher FS at 1 year. However, increased diversity of quasi species in the post-OLT period correlated with a lower FS at 1 year. The dynamics of HCV quasi species in patients who undergo transplantation are predictive of outcome.

Treatment of recurrent hepatitis C infection after liver transplantation with combination of pegylated interferon alpha2b and ribavirin: an open-label series.

BACKGROUND: Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is universal. We aimed to evaluate the efficacy and safety of pegylated interferon (PEG-IFN) and ribavirin (RIB) in the treatment of post-OLT HCV recurrence. METHODS: Thirty-seven patients with recurrent HCV after OLT were screened and began treatment. Nineteen patients have completed therapy. PEG-IFN was started at a dose of 0.5 microg/kg per week and titrated toward a maximum dose of 1.5 microg/kg per week. RIB was started at a dose of 400 mg per day and titrated toward a maximum of 1000 mg per day, as tolerated. Therapy continued for 1 year after HCV replication was undetectable by reverse transcriptase-polymerase chain reaction and was discontinued if there was no virologic clearance at 48 weeks. RESULTS: Twelve patients (63%) completed the combination regimen. Therapy was discontinued in seven (37%) patients. Seven patients (37%) had undetectable viral load at the end of treatment. Of those, five patients (26%) had sustained viral response 6 months after discontinuation of therapy. Five patients (26%) had no virologic response. Necro-inflammatory score declined from 5.22 to 2.89 (P=0.05) in nonresponders versus 6.8 to 2.6 (P<0.01) in responders. Fibrosis stage did not change in either group. Genotype 1-infected patients had a lower likelihood of attaining end of treatment or sustained viral response (P<0.05 for both). CONCLUSIONS: Post-OLT HCV recurrence can be safely treated with PEG-IFN and RIB. Bone marrow toxicity, depression, and rejection are limiting factors that require aggressive management. There was short-term histologic benefit to the use of this regimen, even in those patients without viral clearance.